SES, ACE, and Differentiation

Authored by Jim Edd Jones, Ph. D.

At the 2018 Midwest Symposium on Family Theory and Family Therapy in Willmette, Ilinois this past May, Peter Gianaros from the University of Pittsburgh cogently argued that SES (Socio-Economic Status determined with a composite measure) partially predicts (correlation approximately 0.30) adult serious physiological symptoms, indicators of risk for serious symptoms, and neurobiological indicators of chronic stress/anxiety.  Notice that the correlation is modest, with many exceptions to the correlation.

I would expect that level of differentiation of the individual and/or the family (Diff) would do the same thing, also a modest prediction with many exceptions.  Murray Bowen asserted that lower differentiation family systems have more serious physiological, emotional, and social symptoms.  So far, fragments of evidence from Bowen researchers are consistent with that assertion (Caskie, Baker, Klever, Skowron).

There are pieces of evidence here and there that appear to imply that Diff is also very modestly associated with SES, probably a correlation quite a bit less than 0.30.  That strongly implies that Diff and SES predict different aspects of the symptoms and physiological indicators, and that also implies that a composite measure consisting of Diff and SES would predict more of the physiological symptoms and risk than either alone does.

Oddly, the research on Adverse Childhood Experiences (ACE) supports, I think, some of the Diff assertions.  In some ACE research quite independent of research on SES or Diff, the ACE score for an individual also modestly predicts adult physiological and emotional symptoms, social functioning to some degree, and physiological and neurobiological risk indicators.

Why do I say that ACE research is consistent with the assertion that Diff predicts adult serious symptoms and risk indicators?  When one looks at the ten categories of childhood experiences in the ACE score, they appear to be describing a subset of low differentiation family systems; not all, just a subset.  And despite the popular focus on childhood abuse and neglect, ACE also includes 5 categories of what the researchers call “household dysfunction”.  All ten taken together, to my mind, describe certain kinds of low differentiation families.

I fully suspect that Diff would have a statistical association with ACE.  And some of the ACE research implies a very modest association between ACE and SES.

What are the clinical implications of all this?  Pretty simple.  If you want to understand serious adult conditions, use some kind of composite measure of SES, Diff, and ACE, not just any one of them alone.  Just because one guy in a family is low SES, or one guy in the family was abused as a child, or one guy in a family is at genetic risk for life-threatening asthma does not mean that any of those alone implies or predicts serious adult symptoms.  Probably not so much.  Use a composite of those variables together to make these predictions.

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